Spinal anaplastic ganglioglioma Khan, Amad; Sadek, Ahmed-Ramadan; Fabian, Mark ...
British journal of neurosurgery,
10/2023, Letnik:
37, Številka:
5
Journal Article
Recenzirano
Anaplastic gangliogliomas of the spinal cord are extremely rare with only four cases reported in the literature. Here we present the case of a 22-year-old female who presented acutely with ...quadraparesis and urinary retention. Radiographic imaging demonstrated an intramedullary lesion within the cervical spine. She underwent a cervical laminectomy and resection of the lesion under neurophysiological monitoring. Post-operatively, she regained some function, but remained paraparetic. Histopathology demonstrated an anaplastic ganglioglioma (WHO Grade 3). She subsequently underwent radiotherapy. Following surgery, she remained stable and had MRC Grade 3 Power in all four limbs. Herein, we describe a previously undescribed case of cervical anaplastic ganglioglioma and review the existing literature.
•Spinal arachnoid cysts are rare entities and they are often missed on radiographic imaging.•Microsurgical removal of the thickened arachnoid cap heralds resolution of symptoms in the majority of ...cases.•Myelopathy may develop, but not necessarily.•They may arise as a result of a dissection within the septum positicum.•Turbulent CSF flow within the dissection is suspected to be the cause of the focal cord ischaemia.
Evaluation of the presentation and outcomes associated with surgical marsupialisation of spinal arachnoid cysts and formulation of a putative hypothesis explaining their pathogenesis.
Cases were identified from electronic and theatre records at a single centre. All patients underwent pre-operative assessment and radiographic evaluation with subsequent spinal multidisciplinary discussion. Following surgery patients were reviewed at 6, 12 weeks, 6-months and beyond.
A total of 17 patients with dorsal thoracic arachnoid cysts with a mean age at time of surgery of 58 years with a male to female ratio of 1.8:1 were identified. Paraesthesia (76%), neuropathic pain (76%), weakness (47%) and unsteadiness (53%) were the commonest presenting complaints. Abnormal gait (76%), altered sensation (71%) and weakness (47%) were the most commonly observed signs. Average cyst volume was observed to be 2570 mm3 (sd ±1682, range 544 to 7644 mm3), spanning a median of 2 thoracic levels, with a resultant reduction of cord volume of 33% (sd 12%). A syrinx was associated with 35% of SAC. All cases underwent marsupialisation of the arachnoid cyst. Six months following surgery all patients experienced improvement in at least of one their presenting symptoms and or clinical signs. Weakness, gait and paraesthesia were most likely to improve following surgery. Only 29% of cases had resolution of neuropathic pain, with 13% of the rest reporting an improvement in the sensitivity component of their pain. Clinical improvements correlated with an average 45% (sd 18%) volume increase in previously compressed cord.
Intradural arachnoid cysts commonly present with paraesthesia, neuropathic pain and gait disturbance. Marsupialisation of the SAC heralds immediate and long-term improvement in symptoms. Cysts putatively arise within a dissection in the septum posticum and give rise to both dynamic and static compression of cord parenchyma secondary to the complex CSF flow dynamics within the thoracic spine.
External ventricular drain (EVD) insertion is one of the most common emergency neurosurgical procedures. EVDs are traditionally inserted freehand (FH) in an emergency setting, but often result in ...suboptimal positioning. Image-guided surgery (IGS) is selectively used to assist placement. However, the accuracy and practicality of IGS use is yet to be reported. In this study, the authors set out to assess if IGS is practical and improves the accuracy of EVD placement.
Case notes and images obtained in patients who underwent frontal EVD placement were retrospectively reviewed. Ventriculomegaly was determined by the measurement of the Evans index. EVD location was classified as optimal (ipsilateral frontal horn) or suboptimal (any other location). Propensity score matching of the two groups (IGS vs FH) for the Evans index was performed. Data were analyzed for patient age, diagnosis, number of EVDs, and complications. Those without postoperative CT scans were excluded.
A total of 607 patients with 760 EVDs placed were identified; 331 met inclusion criteria. Of these, 287 were inserted FH, and 44 were placed with IGS; 60.6% of all unmatched FH EVDs were optimal compared with 75% of the IGS group (p = 0.067). The IGS group had a significantly smaller Evans index (p < 0.0001). Propensity score matching demonstrated improved optimal position in the IGS group when compared with the matched FH group (75% vs 43.2%, OR 4.6 1.5-14.6; p = 0.002). Patients with an Evans index of ≥ 0.36 derived less benefit (75% in IGS vs 66% in FH, p = 0.5), and those with an Evans index < 0.36 derived more benefit (75% in IGS vs 53% in FH, p = 0.024). The overall EVD complication rate was 36% in the FH group versus 18% in the IGS group (p = 0.056). Revision rates were higher in the FH group (p = 0.035), and the operative times were similar (p = 0.69). Long intracranial EVD catheters were associated with tip malposition irrespective of the group.
Image guidance is practical and improves the accuracy of EVD placement in patients with small ventricles; thus, it should be considered for these patients.
Neurogenesis is sustained throughout life in the mammalian brain, supporting hippocampus‐dependent learning and memory. Its permanent alteration by status epilepticus (SE) is associated with learning ...and cognitive impairments. The mechanisms underlying the initiation of altered neurogenesis after SE are not understood. Glial fibrillary acidic protein‐positive radial glia (RG)‐like cells proliferate early after SE, but their proliferation dynamics and signaling are largely unclear. We have previously reported a polarized distribution of AMPA receptors (AMPARs) on RG‐like cells in vivo and postulated that these may signal their proliferation. Here, we examined the acute effects of kainate on hippocampal precursor cells in vitro and in kainate‐induced SE on proliferating and quiescent clones of 5‐bromo‐2‐deoxyuridine prelabeled hippocampal precursors in vivo. In vitro, we found that 5 μM kainate shortened the cell cycle time of RG‐like cells via AMPAR activation and accelerated cell cycle re‐entry of their progeny. It also shifted their fate choice expanding the population of RG‐like cells and reducing the population of downstream amplifying neural progenitors. Kainate enhanced the survival of all precursor cell subtypes. Pharmacologically, kainate's proliferative and survival effects were abolished by AMPAR blockade. Functional AMPAR expression was confirmed on RG‐like cells in vitro. In agreement with these observations, kainate/seizures enhanced the proliferation and expansion predominantly of constitutively cycling RG‐like cell clones in vivo. Our results identify AMPARs as key potential players in initiating the proliferation of dentate RG‐like cells and unravel a possible receptor target for modifying the radial glia‐like cell response to SE.
Main Points
AMPAR activation induces the proliferation, cell cycle re‐entry and expansion of hippocampal RG‐like stem cells in vitro and contributes to the expansion of precursor cell populations and subsequent neurogenesis after Status Epilepticus in vivo.
Calcific discitis is a well recognized entity in the paediatric population but more recently has been increasingly reported in adults. It typically involves the lower thoracic vertebrae and is of ...unknown aetiology. Herniation of the calcified fragment is rare but typically occurs out through the annulus fibrosus into the canal space. Herein we describe the first reported case of calcific discitis involving the lumbar vertebrae with subsequent herniation of the calcified disc into and through the anterior aspect of the L5 vertebra. The patient first presented with a history of right back pain and leg sciatica. Radiographic imaging demonstrated calcification within the L4/5 interspace, which was managed with simple analgesia. She subsequently re-presented 24-months later with worsening sciatica, right leg weakness and faecal incontinence. No evidence of cord or root compression was noted on MRI. However, an abnormality was noted at the anterior body of L5 with evidence of superior endplate depression and marrow signal change. Subsequent radionucleide bone studies confirmed a solitary focus of increased linear activity extending across the width of the L4-L5 interspace. Her symptoms were managed medically. Serial radiographic imaging demonstrated regression of the disc space calcification and healing of the L5 fracture. Despite its sinister presentation this condition was self-limiting. We describe the radiographic evolution of this pathology and postulate a putative hypothesis through which it may have arisen.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The acute management of spinal fractures is traditionally split between neurosurgeons and orthopaedic surgeons and the specialities have varying approaches to management. This study investigates ...differences between neurosurgeons and spinal orthopaedic surgeons in the management of spinal fractures at a single trauma centre in the United Kingdom.
A retrospective study at a single trauma centre of patients identified using the Trauma Audit and Research Network (TARN). Case notes and radiological investigations were reviewed for demographics, fracture classification, clinical management and outcomes. Polytrauma cases and patients managed by non-neurosurgical/orthopaedic specialties were excluded.
A total of 465 patients were included in this study (neurosurgery n = 266, orthopaedics n = 199). There were no significant differences between groups for age, gender, Charlson co-morbidity score or distribution of fractures using the AO spine classification. Patients admitted and managed under the orthopaedic surgeons were more likely to undergo a surgical procedure when compared to those admitted under the neurosurgeons (n = 71; 35.7% vs n = 71; 26.8%, p = 0.042, OR 1.56 95%CI 1.056 to 2.31). The median overall length of stay was 8 days and there was no significant difference between teams; however, the neurosurgical cohort were more likely to be admitted to an intensive care unit (24.3% vs 16.2%, p = 0.04).
This study is the first in the United Kingdom to compare neurosurgical and orthopaedic teams in their management of spinal fractures. It demonstrates that differences may exist both in operating rates and outcomes.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: Accidents during sporting activities are a common cause of head injury, particularly in children and young adults. Whilst most sporting head injuries are minor, there remains a ...proportion which is associated with high morbidity and mortality. The epidemiology of sports associated head injuries is variable based on geographical region so the aim of this study was to review the management and outcomes of sporting head injuries managed by a single neurosurgical unit in the South of England.
Method: A retrospective review of the Trauma Audit and Research Network database was conducted for all patients admitted to a tertiary neurosurgical centre over a six-year period (January 2011-December 2016). Case notes were reviewed for demographics, mechanism of injury, injury severity score, intensive care admission, surgical interventions and Glasgow Outcome Score at discharge.
Results: Seventy-six patients (mean age: 37.6 ± 18.4 years, male gender n = 43; 56.6%) were eligible for inclusion in this series. Horse riding accidents were identified as the most common cause of head injury (n = 31; 40.8%). Fifteen patients (19.7%) in this series had a severe head injury (GCS 3-8 on admission). Twenty-eight (36.8%) patients required admission to an intensive care unit and 26 (34.2%) patients underwent neurosurgical intervention. At discharge, 68 (89.5%) patients had a Glasgow Outcome Score 4-5.
Conclusion: The majority of patients with head injuries admitted to a neurosurgical unit can expect a good functional outcome despite the need for intensive care or neurosurgical intervention. The range of sports resulting in head injury is likely influenced by geographic location; however, further national study is required for wider comparison.
•Falls from standing height were responsible for 16% of spinal fractures managed by the major trauma centre.•One quarter of patients with a fracture due to all from standing height had been ...previously diagnosed with osteoporosis.•One sixth of patients required surgical intervention to manage their fracture.•Eighteen percent of patients with a fracture following a fall from standing height died within 6 months after diagnosis.•Higher, and Charlson co-morbidity score and spinal cord injury were associated with higher all cause mortality.
Falls from standing are common, particularly amongst the aging population, due to declining mobility, proprioception and vision. They are often complicated by fragility fractures, including vertebral fractures, that are associated with significant morbidity and may represent a pre-terminal condition with high one-year mortality rates.
A retrospective review of the Trauma Audit and Research Network database for a major trauma centre was conducted for all patients admitted between January 2011 and December 2016. Patients with a spinal fracture and a confirmed fall from standing height were eligible for inclusion. Case notes were reviewed for demographics, Injury Severity Score, Charlson co-morbidity score, treatment, complications and outcomes.
Of 1408 patients with a spine fracture admitted during the study period, 229 (16.3%) were confirmed to be secondary to a fall from standing height. The average age of this cohort was 76.6 ± 14.5 years and 134 (58.5%) cases were female. The average ISS score was 9.7 ± 5.4. The 229 patients sustained 283 fractures with a distribution of: cervical (n = 140), thoracic (n = 65) and lumbar (n = 78) spine. Fifty-six (24.5%) patients underwent surgical intervention. Forty-three patients (18.7%) died within 6 months of admission and all-cause mortality was significantly higher in patients with increasing age and Charlson co-morbidity score.
Spinal fractures due to a fall from standing height represent one sixth of the fracture workload of the emergency spinal service at a major trauma centre. Whilst the majority of patients can be managed conservatively there are still considerable implications for hospital bed usage and patient mortality.
Although chronic subdural hematomas (cSDH) are often treated surgically it remains plausible that invasive treatment in elderly patients may have a negative effect on survival. The aim of this study ...was to characterize survival following neurosurgical intervention for cSDH in a selected cohort aged >90 years and to identify prognostic factors that may inform clinical decision-making.
In total, we identified a cohort of 548 consecutive patients who had undergone burr hole drainage for cSDH in a 5-year period between 2009–2013. Of these patients, 41 were aged >90 years. For each patient, information was gathered from local hospital records, general practice records, and the patients directly. Long-term survival was compared with actuarial data obtained from the National Life Tables.
Overall mortality at the time of discharge was 2%. Mortality was 26.8% at 6 months, 36.8% at 1 year, and 47.9% at 2 years. Interestingly, there was no significant difference between the actuarial curve and the survival curve following surgery (hazard ratio, 1.17; confidence interval, 0.67–2.05; P = 0.57). Despite initially departing from the actuarial curve, the survival curve becomes parallel at approximately 1 year. Multivariate analysis showed that preadmission residence and the number of comorbid conditions were significant predictors of survival.
We advocate that neurosurgical intervention for cSDH in selected nonagenarians can be a safe and beneficial procedure. Patients living independently at home and with a limited past medical history were most likely to benefit from the surgery.
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